This article is part of a series about how we might buy hearing aids in the future and why I think being able to set up our own hearing aids for our own individual hearing loss would be a huge benefit to many people.
The articles in this series are:
The Hearing Aid Industry Needs a Netflix
Hearing Aids Aren't Special
Netflix changed the film and TV industries in a big way. Gone are the days when we had to wait a week for the next episode of our favourite show. We don't have to visit the cinema to watch big movies any more. We are now used to paying a low monthly fee for our content.
Netflix shook up an existing, hugely-profitable industry by giving customers the control the choose what they want to watch when they want to watch it on any device they choose.
The hearing aid industry needs a Netflix to come in and shake it up, to give people options about how they want to buy and use their hearing aids.
If you look back to the earliest articles on Hearing Aid Know (going back 15 years now!) I was probably moaning about this back then, but change is slow...
The hearing aid industry has always had the same way of supplying hearing aids: you go to visit a professional, they test you, fit the hearing aids to your hearing loss, you try them out, they tweak the aids at your request, and you're done. That works for many people but there's still a very large number of people who have a hearing problem who don't have a hearing aid, so it's obviously not working for everyone. We can do better.
Many people are priced out of getting their hearing fixed, aids are very expensive. Many people try a hearing aid for a few weeks and then decide they don't want to keep it, the benefit does not outweigh the cost. It seems that only 34% (1) of the people who could be wearing a hearing aid in the US are and 41% in the UK (2).
Many people just can't be bothered to visit a clinic and go through the whole process or they can't get time off work to book a series of visits. I'm sure there are many other reasons people don't currently have a hearing aid.
For whatever the reasons, it's a fact that there is a huge number of people who would benefit from a hearing aid, the current way of selling hearing aids is not right for them in some way.
Our Version of Netflix
What would our industry-changing Netflix look like? I want to see hearing aids on sale in your local electronic store next to the laptops and the iPhones. So you can pop into the store, pick up a box and take your brand new hearing aid home.
Is this possible? I think it is. Technology has moved fast in the last few years and I think we pretty much have all the pieces we need to make a hearing aid system that can be purchased off-the-shelf and where the consumer can customise it for their hearing loss.
There's a lot of hurdles and it wouldn't be easy, but a forward-thinking company with the right technology could make it work.
Stop Being a Patient
First things first. We need to stop calling hearing aids "medical devices" and we need to stop calling the people who need them "patients".
Historically a hearing aid has been a medical device and has to be fitted by a professional such that it is properly tuned and is safe for the wearer. E.g. you can hear with it and it's not so loud it blows your eardrum out.
The "medical" and "patient" wording around that paints a picture of someone who is sick and who needs to be cured. That alone will put many people off and feeds into the stigma around hearing loss.
I'll go into the technology side of things in a minute but I believe that by putting hearing aids on the shelf in convenience stores we will reduce the stigma around hearing loss. If hearing aids were as simple to get hold of as popping down the shop the barrier to use is much lower and there's no need for "medical" advice or to be a "patient", you are just doing a bit of shopping.
The more people who are wearing hearing aids the more normalised they become and the stigma around them goes away.
Fitting the Hearing Aid
How could we replace the need for professional fitting and aftercare?
I don't think we can 100% replace that, there will always be people who struggle and who need help. People who have a conductive hearing loss will need specialist assistance, maybe surgery or some other solution. But I do think there's a very large segment of people with hearing loss who would hear very well with a self-fitted hearing aid off-the-shelf.
It's my view that pretty much everyone with a mild to moderate sensorineural hearing loss could hear very well with a self-fitted hearing aid.
I'm not suggesting that the science of audiology is easy or that people's hearing losses are always simple to fit, the point here is that good software should make difficult things easy. Well-designed hearing aids and accompanying smartphone app should have the smarts, AI and user interface so that customers are capable of making very simple choices that enable the scientific fitting choices in the background. Basically, the technology is as smart as the professional audiologist and makes the right fitting choices based on a user's instruction via the app.
People with severe losses fall into a grey area, but there's no reason why this off-the-shelf product can't have a return policy for people who don't get on with it. Just like any other product you buy, if you don't like it you can return it within a certain period.
Take me for example, I have a severe hearing loss and I need a custom-fitted mould in my ear to avoid feedback due to the high volumes I need. So I wouldn't be able to just grab an aid off-the-shelf, I'd need someone to create the mould for me, but I'm not your usual hearing loss case.
The steps for fitting a hearing aid are:
1. Getting a pure-tone hearing test (very common).
2. Get a speech in noise hearing test (happens sometimes).
3. Programme the hearing aid to your test results
4. You test the hearing aids out
5. Re-programme if you don't feel they are right
6. Repeat steps 4-5 until you are happy.
We'd need to handle all those steps in the off-the-shelf package and I think today's hearing aid technology allows us to do that easily.
The hearing aid itself can perform the pure tone and speech in noise tests when it's in your ear. I.e. you unwrap your new aid, pop it in your ear and use the smartphone app to set it up. The smartphone app tells you to listen to some beeps and press the screen when you hear something. It then plays you some voices with background noise and tells you to tap the screen to determine what you can understand. The aid sets itself to your test results and you have a base setup to start hearing with.
I don't see any reason why today's hearing aids cannot perform the necessary tests automatically when used with a smartphone to record your answers. Geoff will no doubt be reading this and literally spitting that I haven't mentioned a REM (Real Ear Measurement) test, that would be a bit harder to achieve out-of-the-box as it requires a probe in your ear. But, having said that, GN ReSound's new ONE hearing aid has a speaker in the ear system which could make an automated REM test close enough to be good enough.
To be honest, I don't think REM tests are performed that often by professionals anyway, so even if they couldn't be done automatically you aren't missing out on what you'd get right now from a person. I've been wearing hearing aids for 30+ years, seen lots of different providers and I've never been offered a REM.
Tweaking The Sound To Perfection
Traditionally your hearing aid provider would set up your new hearing aids to your test results and then send you home for a week or two to try out the hearing aids in your everyday environments, then come back for another appointment for any updates that are required.
This is where I think the off-the-shelf system would actually be a huge improvement. So, we've programmed our new hearing aids automatically and now we start using them in our everyday environments, but now we don't have to wait two weeks to get them changed again. Just whip out your smartphone app and make adjustments yourself.
How would a smartphone app do that? How would it know how to change the hearing aids to what you wanted? Well, how does the human professional know how to do it? You tell it. I don't really know how this interface would look but maybe the smartphone app could ask the user a series of questions to determine the issues or it could have a list of issues for the user to pick from.
There will definitely be common problems that people have that are easily diagnosed and fixed, e.g. "everything is too quiet", "cars driving past sound too loud", " I can't hear men's voices very well", "can't hear people behind me" and so on. If you can tell a person the problem with your hearing, you can tell the smartphone app too.
I think a well-designed smartphone app would be a quicker way to fine-tune a hearing aid for personal use. You could make hundreds of tweaks yourself during the two weeks you would normally wait to go back to the professional.
The Reality of a Hearing Loss
There's a big problem with this idea and it's this: it often takes people time to adjust to wearing a hearing aid, for them to adjust to the new sounds, the louder surroundings and for their brain to relearn to understand the sounds in words it hasn't heard for a long time.
We are not so used to buying a product and then having to spend maybe a month getting used to it. When we buy a TV it instantly works when you turn it on. The need to spend time with a hearing aid to really get a benefit could put people off.
Having said that, this is a problem with the current visit-a-pro sales model and one of the reasons people decide not to buy. So it's not a new problem but its definitely something that would need to be addressed and understood by someone buying off-the-shelf.
What's in the Box?
When I talk about a hearing aid being available to buy in a box, I'm not talking about some crappy "hearing enhancer" that is cheap and low quality.
What I want to see in the box in my local electronic store is the latest and greatest instruments from GN, Phonak, Widex, Signia, Oticon etc.
There is absolutely no reason these fantastic devices cannot be purchased directly. They are not dangerous and we don't need specialist help to be safe with them.
Most of the latest hearing aids from the top manufactures already come with great smartphone apps that allow you to modify how it sounds to some degree. It's not a massive leap to update that smartphone software to take a hearing test and improve the sound-changing capabilities.
The technology to make off-the-shelf top-class hearing aid purchasable as non-medical devices is so close I can almost smell it.
So, Who is our Netflix Going to be?
Which company is going to put their hearing aid on the shelf?
Here's another way to ask that question: why hasn't it been done already?
The move is going to be either made by one of the existing hearing aid manufactures or an external company new to the industry. I assume the big incumbent manufacturers must be talking about this is a possibility with the worry that some external player is going to swoop in and steal their lunch.
The hearing aid industry is already doing very well, profits are large. This was the same with the movie and TV industry, the big players were happy and everything was running just fine until Netflix swooped in. Will the same thing happen here?
It would be a brave move by an incumbent to shake up the market as they would upset their current supply chain (the clinics and practices where we currently go to get fitted). If they try off-the-shelf and it doesn't work for them they've severed their old business. Going first would be scary but there are potentially massive profits awaiting.
I think it's more likely that external player will realise the dream and Apple is a very real possibility. They have an eye on health issues, have done work to make hearing aids seamlessly compatible with their phone and have/will release hearing aid features in the next iOS version. They definitely see that there's a market there, they have the resources and brain-power to make it happen.
I think it would be a shame if one of the big incumbent players don't go for it, they have great technology that they have been maturing for many years. Technology that allows me to go from hearing nothing to doing really well, these hearing aids are brilliant and deserve to be in more ears.
How do we Benefit?
Why am I so keen to see this happen?
Think about people who wear glasses or if you do yourself. Do you consider those to be medical devices? Do you worry about wearing glasses because you'll look old/different/stupid/weird? How many people do you know who wear glasses?
Glasses are mainstream consumer products that people don't think twice about buying and using. There's no stigma there. Hearing aids can be this too, the reason they are not is just that they haven't been marketed as such.
The stigma around hearing aids is perpetuated by the hearing aid industry as it stands at the moment.
Hearing aids are too expensive, selling them in a box at Target will drop the price significantly.
A fairly large percentage of the price of a hearing aid is the cost of the professional's time to fit you with it. This pisses me off big time. We are charged a fixed fee on top of the price of the hearing aid for the time regardless of how much we actually use. This is so wrong but has been the way of things for as long as I can remember. No-one has changed that model because it works well enough, manufacturers sell enough aids to make a good profit and clinics see enough patients to make a profit, but it prices so many people out.
When a hearing aid is sold off the shelf, you, of course, would only pay for the price of the product. You could then optionally choose to pay for someone to help you if needed. Not only that the price of the hearing aid itself would drop as more units were sold and competition on the shelf would drive down prices.
I don't see any reason why you couldn't pick up a pair of world-class hearing aids for about the same price as you'd pay for an iPad or iPhone. There's really nothing special about hearing aids that means they have to cost you $4000. They currently cost that much because enough people are prepared to pay that, the price is what the market will bear. Once a company challenges that price point it will go downwards fast.
Pricing and the perception of hearing aids are the two biggest wins but if we see a range of aids available and many more people wearing them then they would become a product that more companies wanted to interface with. By that I mean that once they become commonplace then, for example, Smart TVs would connect to them directly, we'd see smartwatches that could control them, shops and restaurants with Bluetooth connectivity options to make hearing easier. We'd see companies looking to offer Siri-like services and use aids as ways to control other devices. They'd just become another electronic device that you buy and use.
But There's Things (People) I'm Happy With
I've got into a bit of a rant there but I passionately believe this is the future and the key to helping a lot more people hear better.
I also want to say that even though I don't agree with the way hearing aids are currently sold I do 100% endorse the people I have met who supply hearing aids. I've got to know a lot of audiologists, clinic owners and other people working in the industry and without fail they are all passionate about helping people hear better and go the extra mile to do so. So I don't want this article to suggest I think they are doing a bad job, far from it, I've always received excellent service and I see other people getting that too.
But I think the hearing industry as a whole can do much better. You need to shake off the past and bring hearing aids to the masses. If you don't then someone else will and you'll be left watching on the sideline.